What Strategies Do Physicians and Patients Discuss to Reduce Out-of-Pocket Costs? Analysis of Cost-Saving Strategies in 1,755 Outpatient Clinic Visits

Abstract

Background: More than 1 in 4 Americans report difficulty paying medical bills. Cost-reducing strategies discussed during outpatient physician visits remain poorly characterized.

Objective: We sought to determine how often patients and physicians discuss health care costs during outpatient visits and what strategies, if any, they discussed to lower patient out-of-pocket costs.

Design: Retrospective analysis of dialogue from 1,755 outpatient visits in community-based practices nationwide from 2010 to 2014. The study population included 677 patients with breast cancer, 422 with depression, and 656 with rheumatoid arthritis visiting 56 oncologists, 36 psychiatrists, and 26 rheumatologists, respectively.

Results: Thirty percent of visits contained cost conversations (95% confidence interval [CI], 28 to 32). Forty-four percent of cost conversations involved discussion of cost-saving strategies (95% CI, 40 to 48; median duration, 68 s). We identified 4 strategies to lower costs without changing the care plan. They were, in order of overall frequency: 1) changing logistics of care, 2) facilitating co-pay assistance, 3) providing free samples, and 4) changing/adding insurance plans. We also identified 4 strategies to reduce costs by changing the care plan: 1) switching to lower-cost alternative therapy/diagnostic, 2) switching from brand name to generic, 3) changing dosage/frequency, and 4) stopping/withholding interventions. Strategies were relatively consistent across health conditions, except for switching to a lower-cost alternative (more common in breast oncology) and providing free samples (more common in depression).

Limitation: Focus on 3 conditions with potentially high out-of-pocket costs.

Conclusions: Despite price opacity, physicians and patients discuss a variety of out-of-pocket cost reduction strategies during clinic visits. Almost half of cost discussions mention 1 or more cost-saving strategies, with more frequent mention of those not requiring care-plan changes.

Keywords: cost of illness; health expenditures; medical decision-making; out-of-pocket costs; patient-physician communication.

Conflict of interest statement

Ashley Hesson, Ph.D was previously employed and served as a consultant to Verilogue Inc.; Jamison Barnett B.A., M.S., is co-founder and chief technical officer of Verilogue Inc.; Peter Ubel, M.D. serves as a consultant to Humana.

© The Author(s) 2016.

Figures

Figure 1

Prevalence of cost conversations with and without discussion of cost-saving strategies. All visits were between patients >18 years old and specialist physicians in community-based clinics across the United States. *Cost conversation was defined as any mention of the financial costs or insurance coverage associated with the patient’s healthcare. †Discussion of cost-saving strategy was defined as any mention of one or more methods to reduce the patient’s out-of-pocket costs. No evidence was required that the cost-saving strategy was used or pursued, only that it was discussed.

Figure 2

Duration of cost conversations with discussion of cost-saving strategies. The median duration of cost conversations containing discussion of cost-saving strategies (N=231) was 68 seconds (interquartile range, 34 to 117 seconds). The median duration of clinic visits was 9 minutes and 57 seconds. *Discussion of cost-saving strategy was defined as any mention of one or more methods to reduce the patient’s out-of-pocket costs. No evidence was required that the cost-reducing strategy was used or pursued, only that it was discussed.